Department of Paediatrics, College of Medicine, University of Nigeria, Ituku, Ozalla, Enugu, Nigeria.
Department of Community Medicine, Enugu State University College of Medicine, Enugu State, Nigeria.
BMC Cardiovasc Disord. 2024 Aug 28;24(1):455. doi: 10.1186/s12872-024-04104-6.
The application of z-scores in normalizing the cardiac size function and structural dimension will be of immense benefit to the clinician, especially in evaluating children with cardiac anomalies. However, heterogeneity in the obtained z- score results is high, thus a subgroup analysis by region (or continent) to assist healthcare practitioners is necessary.
The review aimed to ascertain the overall mean z-scores for cardiac structures and function.
A thorough search of several databases, EMBASE, PubMed/MEDLINE, and Google Scholar was made. Articles published between January 1999 and December 2023 were recruited, of which the last search was done in December 2023. Keywords used in the search were "z-scores", Children; echocardiography; cardiac structures; cardiac function; and body surface area (BSA)". We restricted our search to children. Besides, additional relevant articles were manually searched. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) was used to highlight selected studies using a pre-defined search protocol. The I statistics were used to ascertain statistical heterogeneity.
Two hundred and forty citations were identified in our search strategy, of which a total of 34 studies were identified. Twenty-four were excluded from the thirty-four studies. A total of 11 studies met our inclusion criteria shown in the PRISMA. Apart from different z scores reading obtained from various countries and regions, some authors focused on few cardiac parameters while others were exhaustive. The mean z-scores of the cardiac structures from various countries/regions range as follows; The range of Z scores obtained by different studies and regions above are as follows; MV;-1.62-0.7 AV: -1.8 -0.5 TV: -2.71 -0.7; PV ; -1.52- (-0.99) MPA; -1-81 -0.8 LPA;-1.07-0.4; RPA;-0.92- 0.1 IVSD; -0.1.77-1.89 LVPWD; -0.12-1.5 LVPWS; -0.1-0.15 LVPWS; 0.03-0.18 LVIDD; -1.13- (-0.98) LVIDS; -0.84-10.3 respectively. The mean z-score from the pooled studies showed mitral valve diameter as -0.24 ± 0.9 and pulmonary valve annuls as -1.10 ± 0.3. The left ventricular end diastolic diameter is -0.93 ± 0.3 while the left ventricular end systolic diameter is -0.05 ± 0.5. The total pooled sample size of the eleven included studies was 9074 and the mean at 95% interval was 824.9 ± 537.344. The pooled mean is presented under the model of the Mean raw (MRAW) column. The heterogeneity discovered among the selected studies was statistically significant.
Due to heterogeneity involved in the reportage of the z-scores of cardiac structures and function, it may be necessary for every region to use their z-scores domiciled in their locale. However, having a pooled mean z-score of cardiac structures and function may be useful in the near future.
z 分数在心脏大小功能和结构维度的标准化中的应用对临床医生非常有益，尤其是在评估心脏畸形的儿童时。然而，所获得的 z 分数结果的异质性很高，因此需要按区域（或大陆）进行亚组分析，以协助医疗保健从业者。
本综述旨在确定心脏结构和功能的总体平均 z 分数。
对几个数据库（EMBASE、PubMed/MEDLINE 和 Google Scholar）进行了全面搜索。纳入了 1999 年 1 月至 2023 年 12 月期间发表的文章，最后一次搜索是在 2023 年 12 月进行的。搜索中使用的关键词是“z 分数”、“儿童”、“超声心动图”、“心脏结构”、“心脏功能”和“体表面积（BSA）”。我们将搜索范围限制为儿童。此外，还手动搜索了其他相关文章。使用预先定义的搜索协议，PRISMA（系统评价和荟萃分析的首选报告项目）用于突出显示选定的研究。使用 I 统计量确定统计异质性。
在我们的搜索策略中确定了 240 条引文，其中共有 34 项研究被确定。从这 34 项研究中排除了 24 项。共有 11 项研究符合我们的纳入标准，如图 1 所示。除了从不同国家和地区获得的不同 z 分数读数外，一些作者专注于少数心脏参数，而另一些则详尽无遗。不同国家/地区的心脏结构平均 z 分数如下；从不同研究和地区获得的 Z 分数范围如下；MV：-1.62-0.7 AV：-1.8-0.5 TV：-2.71-0.7；PV：-1.52-(-0.99)MPA：-1-81-0.8 LPA：-1.07-0.4；RPA：-0.92-0.1 IVSD：-0.1.77-1.89 LVPWD：-0.12-1.5 LVPWS：-0.1-0.15 LVPWS：0.03-0.18 LVIDD：-1.13-(-0.98) LVIDS：-0.84-10.3。汇总研究的平均 z 分数显示二尖瓣直径为-0.24±0.9，肺动脉瓣环为-1.10±0.3。左心室舒张末期直径为-0.93±0.3，而左心室收缩末期直径为-0.05±0.5。十一篇纳入研究的总样本量为 9074 例，95%区间的平均值为 824.9±537.344。汇总平均值显示在“Mean raw（MRAW）”列的模型下。所选研究之间发现的异质性具有统计学意义。
由于心脏结构和功能 z 分数报告的异质性，每个地区可能都有必要使用其在当地的 z 分数。然而，未来可能会有用心脏结构和功能的汇总平均 z 分数。
